From wilderness to an urban ER, a doctor’s journey through Alaska’s best and worst

The wilderness drew Andy Elsberg to medicine. He had a wide-ranging career guiding, mushing and skiing before he went to medical school.

But the wilderness isn't where he ended up. Elsberg works long hours in the emergency department at Providence Alaska Medical Center, dealing with the casualties of gun violence, a drug epidemic, a mental health system in crisis, and all manner of uncontrolled chronic diseases.

"I think I was completely clueless. Pretty soon after getting to medical school I realized wilderness medicine is about healthy people who got hurt," he said. "And emergency medicine is not about that."

Elsberg's unusual career path pairs Alaska's romantic image and darker reality.

We're supposed to be about glaciers, sled dogs and self-reliant adventurers. But most Alaskans live in cities with some of the nation's worst rates of violent crime and substance abuse and with large encampments of the homeless mentally ill.

Our broken social safety net funnels those problems down to emergency rooms, where the doors never close.

[Alaska's only psychiatric emergency room is overflowing. It's a sign of a system breaking down.]

I met Elsberg and his wife, Shannon Brockman, on Anchorage's cross-country ski trails, getting to know them as I passed down my kids' outgrown long underwear to their children, a boy and girl aged 13 and 11. We talked last month in their sunny backyard.

Elsberg, 50, is not a complainer. I had to dig out of him the scary and disturbing stuff he faces at work. He likes the challenge and likes helping those most in need. But Brockman had clued me in about the stories she hears at the end of long shifts of barely controlled chaos.

"There are times when this whole town is exploding," he said.

Elsberg grew up in a middle-class family near Washington, D.C, but dropped out of college to be a ski bum in Vermont, renting and repairing skis at a resort. He's glad he did.

"A lot of parents tell me they don't want me to talk to their kids when we're having this conversation," he said. "I feel like you don't really know what you want to do until you've done a few things."

He was a student in the National Outdoor Leadership School, a famous and challenging adventure program, and NOLS invited him back to be an instructor. At that point, he thought his life would be about outdoor education. The wilderness medicine courses he took were a means to that end.

Elsberg came to Alaska in 1993 to climb Denali — which he did successfully — then worked for NOLS and other guiding companies. He had found where he wanted to be, in big mountains, on snow and crossing glaciers, a skill he compares to dealing with the unexpected in the emergency department.

He was in Fairbanks helping a friend train dogs for the Yukon Quest when he met Brockman through Susan Butcher, the legendary long-distance musher who died in 2006, and Butcher's husband, Dave Monson.

Brockman, a geologist, was already a skilled musher from time spent with a working dog team in Canada, where she is from. In 2002, she was Rookie of the Year in the Quest. Elsberg ran that race in 2004, then Brockman ran the Iditarod in 2005.

"Shannon's the better racer," he said. "I think she's the more competitive person and she keeps a super-positive attitude."

[Here's an example of Alaska legislators actually working together to solve a problem]

She also introduced him to a new career. Elsberg went back to college at University of Alaska Fairbanks, thinking he would be a geologist, like her.

He gave up guiding to work on field seasons that took the couple across the Arctic. The money they earned in the summer allowed them to mush all winter.

But Elsberg liked chemistry better than geology and, at 36, decided to go to medical school. To pay for it, the couple sold their house and dog team and Elsberg applied to the WWAMMI School of Medical Education at the University of Alaska Anchorage, which helps train doctors outside the state who will return to Alaska. He was the oldest student in the program.

The intensity of ER work suits him, but the inability to solve some patients' problems is troubling.

Training at an emergency department in New Mexico, Elsberg said serious problems would pile up, creating typical wait times of six to eight hours. Sometimes patients waited 24 hours, even with painful problems.

Here in Anchorage, wait times are much less. And the Affordable Care Act has made a noticeable difference in the severity of cases.

Before the law expanded coverage, Elsberg said it was not uncommon for patients to come to the emergency department with advanced, metastatic cancer because they had not been able to afford care when a lump originally appeared. That happens much less often now.

Local hospitals also have begun coordinating prescriptions to make it harder to abuse pain pills.

But denying pills to an addict isn't easy. Elsberg said more than one patients has pulled out an IV and tried to spray him with their blood when he said no.

A male patient attacked Elsberg for refusing to order a test he wanted. A female nurse defended him.

Elsberg is proud of the Providence ER and gives credit to the nurses, social workers and other staff who make it work.

But I don't think the community is supporting these caregivers. Elsberg can get an addict through withdrawal, but there aren't enough treatment beds for the next step.

With the city's shortage of alcohol treatment beds, patients show up suicidal at the ER just to be sobered up and sent back to the streets.

This shortage has lasted decades. Why would we expect a different result?

Alaskans approaches wilderness challenges and urban problems differently. As individuals we are good at summiting mountains, but as a community we seem to accept failure.

"Being in a position where all of society's problem are going to end up landing there, there is a huge amount of social work," Elsberg said. "And I'm not trained in social work, I'm trained in medicine."

He added, "And people are coming because they need that help."

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